Healthcare Provider Details

I. General information

NPI: 1720228372
Provider Name (Legal Business Name): SMITH PSYCHOLOGICAL SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2009
Last Update Date: 02/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 SEVEN LAKES DRIVE
SEVEN LAKES NC
27376-0000
US

IV. Provider business mailing address

PO BOX 4
JACKSON SPRINGS NC
27281-0004
US

V. Phone/Fax

Practice location:
  • Phone: 910-778-2427
  • Fax: 910-673-5775
Mailing address:
  • Phone: 910-778-2427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number3503
License Number StateNC

VIII. Authorized Official

Name: DR. CAROL YVONNE SMITH
Title or Position: DIRECTOR/CHIEF PSYCHOLOGIST
Credential: PHD, PHD
Phone: 910-778-2427